We would like to thank Ballo and colleagues for their thoughtful comments on our recent study in Archives.1 We agree that need and benefit of cardiovascular implantable electronic device (CIED) placement should be carefully considered before proceeding with device implantation. A basic principle guiding decisions regarding device placement is to not evaluate the indication for CIED placement2,3 in isolation but to carefully consider the risk of both infectious4 and noninfectious complications associated with implantation. Moreover, the benefit of the device, or lack thereof, in regard to quality of life and long-term survival should be addressed as well. It is the duty of the physician to educate the patient about these risks and benefits, therefore enabling the patient to make an informed decision. When a patient's decision-making capacity is in doubt, caretakers or other individuals with power of attorney should be involved in this complex decision making. We believe that our study contributes to these discussions by elucidating the cost and mortality associated with potential infectious complications of CIED placement.